The Emergency Department Practice Management Association (EDPMA) strongly supports the goal of the No Surprises Act – to keep patients out of the middle of billing disputes.
A lawsuit on appeal before the Second Circuit has sought to dismantle the No Surprises Act (NSA) by holding it unconstitutional. The EDPMA supports the NSA and the patient protections it affords patients however the EDPMA and its partners believe the courts could side with the defendants in this case and make Independent Dispute Resolution (IDR) process the exclusive remedy for resolving billing disputes between payers and providers. For EDPMA, access to courts to pursue out-of-network billing disputes is paramount. EDPMA encourages the court to preserve the NSA and its patient protections, while also preserving providers’ access to the courts as a viable alternative to IDR.
Insurers have abused the NSA and have used it as a tool to slash physician reimbursement. Patient access to care, particularly in the critical emergency medicine context, depends on physicians having efficient and economical means to resolve billing disputes. Accordingly, EDPMA encourages the court to affirm that the No Surprises Act does not interfere with a physician’s right to pursue all available legal remedies, including litigation, to obtain fair reimbursement from insurers. That’s why EDPMA continues to advocate for its members and patients,” says Andrea Brault MD FACEP, EDPMA Chair of the Board.
Click here to view the Amicus Brief.
And almost 96% of outstanding claims are 5+ months old. Read more here.
On February 21, 2023, EDPMA filed an amicus brief in support of the lawsuit led by Texas Medical Association (TMA) that demands the Department of Health and Human Services, Department of Labor and the Department of Treasury (the Departments) reverse its 600% administrative fee increase for clinicians to participate in the Independent Dispute Resolution (IDR) process as intended by the No Surprises Act. The dramatic, unprecedented increase in initial fees disproportionately affects providers, favors health plans, and will hurt patients.
Read the amicus brief and press release.
EDPMA Chair of the Board, Don Powell, DO FACEP, released the following statement regarding the summary judgement issued in favor of the Texas Medical Association (TMA), Dr. Adam Corley and UT Tyler Regional Hospital (collectively “The TMA Plaintiffs”) in “TMA II” and CMS’ subsequent freeze of the federal Independent Dispute Resolution (IDR) process… read more.
On January 31, 2023, EDPMA filed an amicus brief in support of the Texas Medical Assocation (TMA) to ensure the fair and equitable implementation of the No Surprises Act as intended. The TMA’s third lawsuit filed against the federal government asserts that the methodology to calculate the Qualified Payment Amount (QPA) is not only flawed but favors commercial health plan insurers and violates the Congressional intent of the No Surprises Act. TMA’s claims align with EDPMA’s members’ experiences. Read the amicus brief here and press release here.
Emergency medicine physician groups are expected to lose almost $1 billion annually, threatening patient access to emergency care. Read more here.
EDPMA Supports The Texas Medical Association’s Opposition To A 600% Increase In Administrative Fees For Physicians Utilizing The No Surprises Act Independent Dispute Resolution. Read more here.
On Thursday, January 26, 2023, a coalition of over 45 organizations sent a letter to CMS urging the extension of telehealth codes through CY 2024 to align with Congress’ intent under the Consolidated Appropriations Act, 2023, which extends telehealth flexibilities through CY 2024. The letter can be found here.
On Monday, January 23, 2023, EDPMA joined a coalition of over 100 organizations urging Congress to reform the Medicare payment system. The letter can be found here.
On Thursday, January 19, 2023, EDPMA and ACEP sent a letter to the Tri-Agencies thanking them for the early January conversation and providing additional input and more detailed recommendations. The letter can be found here.
On Monday, January 23, 2023, ACEP issued a press release regarding the letter and it can be found here.